Medicare ratings of Medicare Advantage plans a farce

The Centers for Medicare and Medicaid Services (CMS) recently sanctioned Cigna for threatening the health and safety of its members in Medicare Advantage plans. But, notwithstanding Cigna’s sanction and “its longstanding history of noncompliance with CMS requirements,“ a new CMS policy allows Cigna to retain its multi-star ratings, making Medicare ratings of Medicare Advantage plans a farce.

The sanctions against Cigna, imposed in January 2016, preclude Cigna from enrolling new Medicare Advantage members or marketing its plans to prospective members. According to CMS, “Cigna’s conduct poses a serious threat to the health and safety of Medicare beneficiaries.” But, the new CMS policy means that Cigna is still eligible to receive hundreds of millions of dollars in financial rewards from Medicare.

And, because the new policy allows Cigna to keep its multi-star ratings, the star ratings also mislead people who are looking at Medicare’s star ratings as they consider whether to join a Medicare Advantage plan. Medicare star ratings are supposed to indicate a health plan’s performance, including the quality of its care. But, CMS reports that Cigna has delayed and denied its members access to medical services and prescription drugs as well as increased their members’ out-of-pocket costs for care in violation of CMS requirements.